Healthcare Provider Details

I. General information

NPI: 1972290104
Provider Name (Legal Business Name): PRINCE KWABENA GYAMFI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 MAIN ST STE 1M
BRIDGEPORT CT
06606-4201
US

IV. Provider business mailing address

1290 SILAS DEANE HWY HHC-CVO
WETHERSFIELD CT
06109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 475-210-5718
  • Fax:
Mailing address:
  • Phone: 475-210-5718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number86088
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: